Prenatal Diagnosis of Fetal Retroesophageal Left Brachiocephalic Vein With HDlive-Flow Render Mode and Spatiotemporal Image Correlation

A 29-year-old pregnant woman was diagnosed at 24 weeks of gestation with a suspected vascular ring in the fetus, but no other intracardiac anomalies. 2D ultrasound revealed an aberrant vessel coursing transversely behind the trachea and subsequently joining the superior vena cava (SVC) through a dilated azygos (Az) vein (Figure A). 2D color Doppler ultrasound showed the left brachiocephalic vein (LBCV) behind the descending aorta, trachea and esophagus, then draining into the SVC through the dilated Az vein (Figure B). 4D color Doppler ultrasound with spatiotemporal image correlation (STIC) and HDlive-flow render mode clearly showed the retroesophageal LBCV travelling from left to right and draining into the SVC (Figure C–F).

Figure.

Echocardiography (A–D) and schematic (E,F) of fetus with retroesophageal left brachiocephalic vein (LBCV). (A,B) 2D and color Doppler imaging show the retroesophageal LBCV (arrows) coursing transversely behind the trachea and subsequently joining the superior vena cava (SVC) through the dilated azygos vein (Az). (C,D) 4D images with spatiotemporal image correlation and HDlive-flow mode showing the spatial relationships of these vessels. AO, aorta; DAO, descending aorta; INA, innominate artery; LAA, left aortic arch; LCA, left carotid artery; LDA, left ductus arteriosus; LSA, left subclavian artery; PA, pulmonary artery; RBCV, right brachiocephalic vein; T, trachea.

Retroesophageal location is a very rare abnormality of the LBCV, with an incidence of 0.19% in children with congenital heart disease.¹ Retroesophageal LBCV is commonly associated with right-sided aortic arch, followed by ventricular septal defect. STIC combined with HDlive-flow mode is a novel technique that enabled acquisition of fetal heart volume and visualization of cardiac structures such as the cardiac chambers, great arteries and veins.

Disclosures

The authors declare no conflicts of interest. This study was granted an exemption by the Medical Ethics Committee of Gansu Provincial Maternity and Child-care Hospital.

Availability of Data and Materials

The deidentified participant data will not be shared.

Reference

• 1.   Han J, Sun L, Gu X, Zhang Y, Guo Y, Hao X, et al. Prenatal diagnosis of the fetal retroesophageal left brachiocephalic vein: Case series and review of the literature. J Ultrasound Med 2020; 39: 397–405.